R.H. Foye

Fluoride Uptake and Release Characteristics of Glass lonomer Cements

The aims of this study were firstly to investigate the fluoride-releasing characteristics of five commercial glass ionomer materials: Ketac Fil, Chemfil Superior, Fuji II LC, Aquacem and Vitrebond. The second aim was to assess the fluoride uptake and subsequent release from the same range of materials. In both tests, ten discs, 6 mm in diameter with a thickness of 1.5 mm, were made for each material. The initial fluoride release was assessed over a 60-day period for all materials. Each disc was immersed in 2 ml of de-ionised water within a plastic vial. The solutions were changed daily up to day 15, and thereafter every 3 and 4 days until the end of the test. All of the materials released measurable amounts of fluoride throughout the test period, with a considerable range on day 1 (15.3-155.2 ppm F). The concentration of fluoride released on the 2nd day fell sharply for all materials (range 6.3-44.3 ppm F). By day 60 all materials continued to release fluoride, albeit to a lesser extent (range 0.9-3.99 ppm F). With regard to the uptake and release of fluoride, a similar protocol was employed, although all samples were immersed in 1 litre of de-ionised water for 60 days to allow the majority of the fluoride to leach out from the materials. The ten pellets for each material were divided into two groups, five samples as control and five samples as test. Each day over a 20-day period all test samples were exposed to a 1000-ppm F solution for 2 min.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of saliva on enamel and dentine erosion

The present study aims to assess the ability of saliva, both in vitro and in situ, to prevent surface mineral loss from enamel and dentine when exposed to an erosive challenge. Fifteen groups of four varnished thin tooth sections were stored in saliva collected from individuals taking part in the in situ study and a further eight groups, each containing four sections, were stored in deionised water. In vitro, sections were stored in saliva or water for 14 days. In addition, fifteen subjects each wore an appliance with four varnished sections. Appliances with sections were worn for 14 days. All sections were exposed to 25 ml of erosion solution for 5 min twice daily. Microradiography and image analysis of the recovered sections demonstrated significant protection of surface mineral loss from enamel and dentine by saliva in vitro and in situ compared with deionised water (p < 0.05). Significantly less mineral loss (p < 0.05) was observed for enamel and dentine stored in situ compared with storage in saliva in vitro. Generalised linear modelling demonstrated both the subject and protocol had significant effect on mineral loss. A weak positive correlation (r = 0.64) was noted when in situ and in vitro mineral loss from enamel were compared, demonstrating greater reactivity of the in vitro enamel specimens to the erosion challenge. The dentine data did not show any linear correlation. Saliva protected against mineral loss by erosion and, for enamel, in vitro results demonstrated a weak positive correlation with in situ results.

Fluoride release and cariostatic ability of a compomer and a resin-modified glass ionomer cement used for orthodontic bonding

OBJECTIVES The aims of this study were to compare the local and systemic uptake of fluoride released from a compomer material (Dyract Ortho) and a resin-modified glass ionomer cement (Vitremer) with that of a conventional resin adhesive (Right-On) and to compare the cariostatic ability of each of the test materials with that of the resin control. METHODS Twenty six patients were randomly allocated to have a bracket bonded to a premolar on one side of the arch with one of the test materials and on the opposite side with the control material. Premolars destined for extraction as part of an orthodontic treatment plan were selected for bonding. A non-fluoride toothpaste was used by all participants for 4 weeks prior to bracket bonding and throughout the 4 week trial period. Fluoride release was measured in saliva, plaque and urine samples taken pre-bonding and 4 weeks post-bonding. Enamel demineralisation was assessed by scoring the buccal surface of each extracted tooth using a caries index. RESULTS Neither Vitremer nor Dyract Ortho altered salivary or urinary fluoride concentration significantly 4 weeks post-bonding but plaque fluoride concentration increased significantly around premolars bonded with Vitremer. The test materials as a combined group were associated with significantly less demineralisation than the control material but there was no significant difference in cariostatic ability detected between either Dyract Ortho or Vitremer when each group was compared separately with the control. CONCLUSIONS Fluoride released from Dyract Ortho or Vitremer is likely to exert a local and not a systemic effect. In a 4-week clinical study, the cariostatic ability of the fluoride-releasing cements, as a combined group, was superior to that of the non-fluoride releasing control but there was no significant difference in cariostatic ability between the two test materials when each test group was compared separately with the control.

Application of Transverse Microradiography for Measurement of Mineral Loss by Acid Erosion

This paper describes a novel application of transverse microradiography for the detection and quantification of mineral loss due to acid erosion in thin tooth sections. Sixty-four specimens were randomly divided into eight equal-sized groups and exposed to an orthophosphoric-acid-based erosive fluid (pH = 3) for 0, 0.25, 0.5, 1, 2, 5, 12, or 24 hrs. We made microdensitometric scans separately across both enamel and dentin to derive data for the total mineral loss and the minimum mineral content within the eroded area. We then analyzed specimens using a profilometer to determine (1) the area above a plot of penetration depth against distance and (2) the maximum depth of penetration. Correlation coefficients for comparisons between microradiographic and profilometric data for both enamel and dentin specimens varied between 0.87 and 0.96. Two-sample t tests demonstrated that the microradiographic technique could detect early erosion, i.e., discriminate between erosion times of less than 1 hr. It was concluded that this application of transverse microradiography was a useful and acceptable method for the measurement of early mineral loss in vitro, occurring as a result of acid erosion.

The Effect of Chewing Gum Use on in situ Enamel Lesion Remineralization

Two independent cross-over studies investigated the possibility of enhanced early enamel lesion remineralization with the use of chewing gum. The first study involved a sorbitol-containing chewing gum, and the second, which had an identical protocol, tested a sucrose-containing chewing gum. In each study, 12 volunteers wore in situ appliances on which were mounted enamel sections containing artificial caries lesions. Subjects brushed twice daily for two min with a 1100-ppm-F (NaF) dentifrice (control and test) and in the test phase chewed five sticks of gum per day for 20 min after meals and snacks. Microradiographs of the enamel lesions were made at baseline and at the end of the seven-week experimental period. In the sugar-free gum study, the weighted mean total mineral loss (Az) difference [(wk7 - wk0) x (-1)] was 788 vol.% min. x μm for the gum, corresponding to remineralization of 18.2%, vs. the control value of 526 vol.% min. x μm, 12.1% remineralization (p = 0.07). There were no significant differences for the surface-zone (p = 0.20) and lesion-body (p = 0.28) values. In the sucrose-containing gum study, the Az difference was 743 vol.% min. x μm for the gum, corresponding to a remineralization of 18.3%, vs. the control value of 438 vol.% min. x μm, 10.8% remineralization (p = 0.08). The surface-zone values were not significantly different (p = 0.55). For the lesion body, however, the sucrose-containing gum value of 6.11 vol.% min. was significantly different (p = 0.01) from that of the control (2.81 vol.% min.).

Fluoride release, microbial inhibition and microleakage pattern of two orthodontic band cements

OBJECTIVES To compare, in vitro, the fluoride release, microbial inhibition and microleakage pattern of a conventional glass ionomer cement (Ketac-Cem) and an acid-modified composite (Ultra Band-Lok) for band cementation. METHODS Fluoride release was measured from cement discs (3.0 mm diameter and 1.5 mm thick) at regular intervals over 40 days using a potentiometric method. Microbial inhibition was determined for each cement using an agar diffusion test against one of four different strains of Streptococcus mutans. Thirty pairs of banded third molars (15 banded pairs for each cement) were thermocycled and microleakage determined by a dye penetration method. The depth of microleakage was assessed by an index applied by two examiners independently to photographic records taken of the mid-buccal aspect of each tooth. RESULTS The cumulative and daily fluoride release for days 5, 15 and 40 were significantly greater for Ketac-Cem than for Ultra Band-Lok (all p < 0.05). After the initial set, the anti-microbial activity was significantly greater for Ketac-Cem than for Ultra Band-Lok over the following 24 h period for all four strains of S. mutans (all p < 0.05). There was no significant difference between the two cement groups for microleakage at the cement/enamel interface (p = 0.66) but a borderline significance was detected for microleakage at the cement/band interface (p = 0.051). CONCLUSIONS The fluoride release and anti-microbial activity of Ketac-Cem were greater than that of Ultra Band-Lok. There was no significant difference in microleakage between the cements at the cement/enamel interface but a borderline difference existed between the cements at the cement/band interface.

The release of mercury from dental amalgam and potential neurotoxicological effects

OBJECTIVES The aim of this study was to estimate the amount of mercury released into both air and saliva from fresh and aged, abraded amalgam discs and then investigate neurotoxic effects of inorganic mercury upon sensory neuronal cultures. METHODS An air-tight chamber was constructed to allow the combined estimation of mercury species released from amalgam pellets. The level released into air and saliva from both freshly packed and aged-abraded amalgam pellets was assessed. Dorsal root ganglia cultures from male CBA mice were exposed to 1 and 10 microM mercuric chloride concentrations. The effects of this were assessed by means of morphology, adhesion, size and immunocytochemistry. RESULTS The mercury released into air from dry fresh amalgam was low and less than the recommended industrial exposure limit for mercury. However, covering the discs with saliva reduced air-mercury levels by 46-56% and there was a statistically significant difference in the air-mercury levels recorded (p=0.013-0.048). The mercury released into air from dry abraded amalgam was shown to be above the recommended industrial limit. Coating the abraded amalgam discs with saliva reduced the mercury by 66-72% with the levels recorded being significantly lower (p<0.001). The level of total mercury within the saliva was found to be highly variable. Little change was noted in the neuronal cultures treated with 1 microM mercuric chloride. However, the cultures exposed to high level (10 microM) mercuric chloride showed cells that became rounded and clumped together indicating pathological change. CONCLUSIONS Amalgam placement appears to present minimal mercury exposure risk. To reduce the amount of mercury released into air, however, amalgam should be polished in a moist atmosphere with high volume aspiration. The neurotoxic effect of mercury appears to be related to concentration, as only in the cultures treated with 10 microM mercuric chloride showed striking qualitative and quantitative cellular changes.

Fluoride release from orthodontic cements—effect of specimen surface area and depth

OBJECTIVE The aims of this in vitro study were firstly to compare fluoride release from a disc model of two orthodontic cements with various surfaces varnished, reducing the surface area by 25, 50 and 75%; secondly, to measure the fluoride release from previously exhausted discs of the same cements following removal of various depths of surface material. METHODS Forty discs of each cement, Fuji Ortho LC and Ultra Band-Lok, (6mm diameter by 3mm) were divided into two groups of 20 discs each. For each material, the first group was divided further into four groups of five discs, one group acting as control, while the other three groups were varnished reducing the surface area by 25, 50 and 75%, respectively. The second group was exhausted initially over a 60 day pre-experimental period and was subsequently divided into four groups of five discs, one group acting as control. The other three groups had material ground from one of the flat surfaces, to depths of 10, 100 or 1000 microm, to reveal a fresh surface. In both studies, the discs were immersed either daily (up to day 20) or twice weekly (up to day 60) in fresh 2ml aliquots of deionised water. The fluoride concentration in the deionised water was measured at the end of the experimental period. RESULTS For each cement, the relationship between the cumulative fluoride release and the percentage of the surface covered was clearly non linear at both 5 and 60 days. Fuji Ortho LC proved to release significantly greater amounts of fluoride at both 5 days and 60 days compared with Ultra Band-Lok. The results for Ultra Band-Lok were also significant when compared to the control group, but significantly less fluoride was released when compared with Fuji Ortho LC. When comparing the 25 and 50% covered discs, the amount of fluoride released was not significantly different for both cements. Furthermore, the relationship between fluoride release and depth was clearly non linear for both cements. CONCLUSIONS For the materials tested in this study, reducing the surface area of the discs did not reduce the cumulative fluoride release in a linear fashion. In addition, the previously exhausted discs began to release fluoride again, but this fell to concentrations similar to the control discs after the initial 5-day period for both cements. This suggests that further traces of previously unreleased fluoride had become available from the subsurface of these cements. The pattern of fluoride release was similar for all models tested.

Daily exposure to fluoride mouthrinse produces sustained fluoride release from orthodontic adhesives in vitro

OBJECTIVES To determine firstly, if sustained fluoride release can be achieved from five orthodontic adhesives: Ketac-Cem, Fuji ORTHO LC, Sequence, Transbond and Right-On, with daily exposure to fluoride mouthrinse in vitro, and secondly, if sustained fluoride release can be re-established from the same specimens, after an interruption in mouthrinse exposure. METHODS Ten brackets were bonded to bovine incisors using each adhesive. Each adhesive group was divided equally into a test and a control sub-group. In phase 1 (42 days), the test sub-groups were exposed for 1min daily to fluoride mouthrinse (225 ppm), followed by immersion in de-ionised water for 42 days to deplete their fluoride reserves. Mouthrinse exposure was then resumed in phase 2 (28 days). Mean cumulative fluoride release (MCFR) was calculated for days 0-21 of phase 1 and for the plateau portion of the fluoride release curves in phase 1 (days 21-42) and phase 2 (days 7-28). RESULTS During phase 1, the MCFR for each test sub-group was significantly greater than its control (p<0.05). There was no significant difference in MCFR between the curve plateau portion of phases 1 and 2 for all adhesives except Transbond, for which MCFR was less in phase 2 (p<0. 05). CONCLUSIONS Sustained fluoride release occurred for each adhesive exposed daily to fluoride mouthrinse, at a level significantly greater than its control. After fluoride exhaustion, re-exposure to daily fluoride mouthrinse produced sustained fluoride release levels comparable to those prior to exhaustion, for all adhesives except Transbond.

Determination of Plaque pH Changes within the Trough of an in situ Appliance Used to Study Mineral Changes in Early Carious Lesions

Plaque pH was measured using a glass combination pH microelectrode of plaque deposits lining the trough of an intra-oral appliance which contained single sections of human teeth with artificial enamel lesions. Plaque exposure to a 10% sucrose solution produced significantly lower plaque pH levels than a solution of sorbitol gum extract. The subsequent flow of saliva over the plaque/pH electrode interface resulted in a significant and rapid increase in pH. Repeat experiments, using deionised water instead of saliva, demonstrated no increase in pH at the plaque/electrode interface. This system may provide a convenient method of producing plaque suitable for repeated pH analysis in intimate association with artificial enamel lesions. This may permit further study of the relationship between plaque acidogenicity, salivary buffering capacity and mineral change within the incipient enamel lesion.